Study reveals sex differences in care and outcomes of children and teens with type 1 diabetes

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The European Association for the Study of Diabetes (EASD), Annual meeting in Stockholm, Sweden (19 – 23 Sept) revealed that type 1 diabetes (T1DM), is more common in girls than it is in boys.

Silvia de Vries, from Amsterdam University Medical Centers in The Netherlands, and her colleagues conducted a systematic review that synthesized all available evidence regarding sex differences in care and outcomes for children and adolescents (aged 18 and younger).

De Vries states that increasing awareness of type 1 diabetes is key to reducing disparities in care and reducing the chance of life-threatening complications later on in life, such as heart disease or kidney failure. “Our troubling inequalities call for urgent and targeted efforts such as increased surveillance in daily clinical practice and cardiovascular prevention, sex-appropriate diabetes ketoacidosis awareness campaigns, and screening of quality life tailored for adolescent girl.

T1DM is the most common childhood chronic disease, affecting around 1.1 million children and teens worldwide. T1DM occurs when the immune system attacks insulin-producing cells in your pancreas. As a result, your body produces very little insulin or increases blood sugar dangerously high. People with T1DM must inject insulin for their entire lives in order to stay alive.

T1DM can be dangerous because it is often not diagnosed until severe, sometimes life-threatening symptoms develop. Longer disease duration and younger age at diagnosis increase the likelihood of long-term complications like kidney failure, stroke, heart attacks, stroke, nerve injury, blindness, vascular problems, and reduced life expectancy.

There have been differences in the outcomes and cardiovascular care of adult patients with T1DM. T1DM patients who are women have a 40% greater risk of death from any cause and twice as many deaths from nonfatal vascular events than those with T1DM. It is not yet known if sex can influence care and outcomes for children.

De Vries and coworkers conducted a systematic review to examine observational studies that looked at sex differences between patients and diseases, treatment, complications, and patient characteristics in T1DM children (aged 18 or under) from June 2021 through June 2021. The review included 90 studies on important outcomes that are relevant to daily care processes from the 8,640 articles.

Analysing data from 89.700 children revealed that 7 of 10 studies showed a higher body mass index (BMI). Similar results were found for adolescent boys (7 studies, 33.153 kids), with levels of obesity and dyslipidemia (unhealthy levels or cholesterol in the blood) higher than in girls.

Studies that focused on blood sugar control, which is one of the most important indicators for long-term complications, showed a similar picture. In 21 studies that included 144,613 young patients, the average blood sugar (hemoglobinA1c), was 6.4 mmol/mol lower in girls undergoing treatment. This difference was also evident at diagnosis and in studies that showed an increase in average sugar over time.

Additionally, insulin pump therapy (6 studies, 213,324 young people) was more common in girls and required higher insulin doses.

Young females were more likely to have diabetes-related comorbidities such as celiac disease and thyroid disease.

It is unclear what the exact causes of this disparity in metabolic control are between boys and girls. However, evidence suggests that diabetes management may be more difficult for girls than it is for boys. Some differences are evident before puberty. They may be caused by differences in body composition and fat distribution. In addition, there may be behavioral differences between girls and boys in childhood that play a role.

Eight studies, involving 3,561 young people, looked at the serious complication diabetic ketoacidosis. They found similar results when DKA was diagnosed. DKA during treatment, and more severe DKA that required hospitalization, were more common in girls.

Diabetic ketoacidosis can be caused by insufficient insulin medication or an infection that leads a dangerous accumulation acid in the blood. This is due to excess sugar and insufficient insulin. DKA can cause severe complications, such as fluid replacement and insulin therapy. It can even lead to death.

According to the authors, the increased incidence of DKA after diagnosis could be an indication that sex differences may already have been present in the first stages of the disease. There may be differences in the presentation of symptoms and disease progression between the sexes. The caregivers and the treatment team may interpret these initial signs differently, which should be addressed.

However, studies have shown that partial diabetes remission and hypoglycemia (low blood sugar) are more common in boys.

Data from 15 studies with 8,722 teens and children revealed that all 15 studies found a lower quality life for teenage girls. Results also showed that diabetes-related distress and fear of hypos are more common in girls.

De Vries states that “Improving disease-related skills and quality of living during this vulnerable period could be an important strategy to improve glucose control and reduce the risk of complications.” “All young adults with type 1 should receive tailored care to meet their needs in order to manage their condition effectively. There is no reason why type 1 diabetes patients can’t live longer and healthier lives if they have the right support and care.

The authors acknowledge that their results are based upon observational studies and cannot be used to draw direct causal connections between sex, the studied outcomes, and the observed results. They also point out that their goal was to identify sex differences within current pediatric diabetes care. This could lead to an under representation of studies that have neutral outcomes. This may limit the conclusions that can be drawn.

Teens may have better control of their blood sugar levels, which could limit the damage to their brains from diabetes-related complications.

Study shows that there are differences in the care and outcomes of type 1 diabetic children and teens between sexes (2022, September 20).
Retrieved 21 September 2022
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